Toprol-XL

NOTICE: This Consumer Medicine Information (CMI) is intended for persons living in Australia.

TOPROL-XL™ 23.75, 47.5, 95, 190 TABLETS

23.75, 47.5, 95, 190 TABLETS

Metoprolol succinate

Consumer Medicine Information

What is in this leaflet

This leaflet answers some of the common questions people ask about TOPROL-XL tablets.
It does not contain all the information that is known about TOPROL-XL.

It does not take the place of talking to your doctor or pharmacist.

All medicines have risks and benefits. Your doctor will have weighed the risks of
you taking TOPROL-XL against the benefits they expect it will have for you.

If you have any concerns about taking this medicine, ask your doctor or pharmacist.

Keep this leaflet with the medicine.

You may need to read it again.

What TOPROL-XL is used for

TOPROL-XL belongs to a group of medicines called beta-blockers.

TOPROL-XL tablets are used to treat heart failure. It is used in combination with
other medicines to treat your condition.

It works by affecting the body's response to some nerve impulses, especially in the
heart. As a result, it decreases the heart's need for blood and oxygen and therefore
reduces the amount of work the heart has to do. It also helps the heart to beat more
regularly.

Ask your doctor if you have any questions about why TOPROL-XL has been prescribed
for you.

Your doctor will have explained why you are being treated with TOPROL-XL and told
you what dose to take.

Your doctor may have prescribed this medicine for another reason.

Follow all directions given to you by your doctor carefully.

They may differ from the information contained in this leaflet.

TOPROL-XL is not addictive.

Before you take TOPROL-XL

When you must not take it

Do not take TOPROL-XL tablets if:

you have any allergies to metoprolol succinate, the active ingredient in TOPROL-XL
tablets, or any of the ingredients listed at the end of this leaflet, or any other
beta-blocker medicine.

Some of the symptoms of an allergic reaction may include shortness of breath, wheezing
or difficulty breathing; swelling of the face, lips, tongue or other parts of the
body; rash, itching or hives on the skin or you may feel faint.

you have or have had asthma difficulty in breathing, wheezing, bronchitis or other
lung problems in the past

you have a history of allergic problems, including hayfever

you have low blood pressure

you have a very slow heartbeat (less than 45-50 beats/minute)

you have certain other heart conditions

you have phaeochromocytoma (a rare tumour of the adrenal gland) which is not being
treated already with other medicines

you have a severe blood vessel disorder causing poor circulation in the arms and legs

you are receiving/having emergency treatment for shock or severely low blood pressure.

If you are not sure whether any of these apply to you, check with your doctor.

Do not use TOPROL-XL if the expiry date (EXP) printed on the pack has passed or if
the packaging is torn or shows signs of tampering.

If it has expired or is damaged, return it to your pharmacist for disposal.

Do not give TOPROL-XL to children.

The safety and effectiveness of TOPROL-XL in children has not been established.

If you are not sure whether you should start taking this medicine, talk to your doctor.

Before you start to take it

Tell your doctor if you have any allergies to:

metoprolol succinate or any of the ingredients listed at the end of this leaflet

any other medicine including other beta-blocker medicines

any other substances, such as foods, preservatives or dyes

Tell your doctor if you have, or have had, any medical conditions, especially the
following:

Like most beta- blocker medicines, TOPROL-XL is not recommended for use during pregnancy.

Tell your doctor, if you are breast-feeding or plan to breast-feed

The active ingredient in TOPROL-XL passes into breast milk and therefore there is
a possibility that the breast-fed baby may be affected.

If you have not told your doctor about any of these things, tell them before you take
TOPROL-XL.

Taking other medicines

Tell your doctor or pharmacist if you are taking any other medicines, including any
that you get without a prescription from your pharmacy, supermarket or health food
shop.

Some medicines and TOPROL-XL may interfere with each other. These include:

other beta-blocker medicines, including beta-blocker eye drops

calcium channel blockers or calcium antagonists, medicines used to treat high blood
pressure and angina, for example verapamil and diltiazem

medicines used to treat high blood pressure, for example clonidine, hydralazine, and
prazosin

medicines used to treat abnormal or irregular heartbeat, for example amiodarone, disopyramide
and quinidine

medicines used to treat arthritis, pain, or inflammation, for example indomethacin
and ibuprofen

digoxin, a medicine used to treat heart failure

medicines used to treat diabetes

medicines used to treat bacterial infections, for example rifampicin

cimetidine, a medicine used to treat stomach ulcers

medicines used to treat depression

warfarin, a medicine used to prevent blood clots

monoamine-oxidase inhibitors (MAOIs)

These medicines may be affected by TOPROL-XL or may affect how well it works. You
may need to take different amounts of your medicine, or you may need to take different
medicines. Your doctor will advise you.

Your doctor and pharmacist have more information on medicines to be careful with or
avoid while taking TOPROL-XL.

If you have not told your doctor about any of these things, tell them before you take
any TOPROL-XL.

How to take TOPROL-XL

Follow all directions given to you by your doctor or pharmacist carefully.

They may differ from the information contained in this leaflet.

If you do not understand the instructions on the pack, ask your doctor or pharmacist
for help.

How much to take

The usual starting dose is half a 23.75 mg or a whole 23.75 mg tablet once a day for
one to two weeks. The dose is then usually doubled every second week up to a maximum
dose of 190 mg once daily or to the highest tolerated dose.

TOPROL-XL tablets may be broken in half or swallowed whole with a glass of water as
directed by your doctor. TOPROL-XL tablets should not be chewed or crushed.

If you are taking other medicines your doctor may need to change the dose of them
to obtain the best results for you.

When to take TOPROL-XL

Take your medicine at about the same time each day, preferably together with the morning
meal.

Taking it at the same time each day will have the best effect. It will also help you
remember when to take it.

How long to take TOPROL-XL

Continue taking your medicine for as long as your doctor tells you. This medicine
helps to control your condition, but does not cure it.

It is important to keep taking your medicine even if you feel well.

DO NOT STOP TAKING TOPROL-XL TABLETS SUDDENLY.

The dose needs to be reduced slowly over 7 to 14 days to make sure that your condition
does not get worse. Your doctor will tell you how to gradually reduce the dose before
stopping completely.

If you forget to take it

If you forget to take a dose of TOPROL-XL, skip the dose you missed and take your
next dose when you are meant to.

Do not take a double dose to make up for the dose that you missed.

If you are not sure what to do, ask your doctor or pharmacist.

If you have trouble remembering when to take your medicine, ask your pharmacist for
some hints.

Overdose

Telephone your doctor, the Poisons Information Centre (13 11 26) or go to casualty
at your nearest hospital immediately if you think that you or anyone else may have
taken too much TOPROL-XL. Do this even if there are no signs of discomfort or poisoning.
You may need urgent medical attention.

If you take too many TOPROL-XL tablets your blood pressure may drop too far. You will
feel faint or may faint, and your heart rate will also slow down. You may also have
nausea, vomiting and shortness of breath. In extreme cases, serious heart and lung
problems may occur.

While you are using TOPROL-XL

Things you must do

Be sure to keep all of your doctor's appointments so that your progress can be checked.

If you become pregnant while taking TOPROL-XL, tell your doctor immediately.

If you have a severe allergic reaction to foods, medicines or insect stings, tell
your doctor immediately.

If you have a history of allergies, there is a chance that TOPROL-XL may cause allergic
reactions to be worse and harder to treat.

If you feel light-headed, dizzy or faint when getting out of bed or standing up, get
up slowly.

You may feel light-headed or dizzy when you begin to take TOPROL-XL. This is because
your blood pressure has fallen suddenly.

Standing up slowly, especially when you get up from bed or chairs, will help your
body get used to the change in position and blood pressure. If this problem gets worse
or continues, talk to your doctor.

If you feel a worsening of your condition in the early stages of taking TOPROL-XL,
tell your doctor immediately.

Some people may experience an apparent worsening of their condition in the early stages
of treatment with TOPROL-XL. It is important to tell your doctor if this happens to
you, although it is usually temporary. If your condition continues to worsen, you
should see your doctor as soon as possible.

Make sure you drink enough water during exercise and hot weather when you are taking
TOPROL-XL, especially if you sweat a lot.

If you do not drink enough water while taking TOPROL-XL, you may feel faint or light-headed
or sick. This is because your blood pressure is dropping too much. If you continue
to feel unwell, tell your doctor.

If you are being treated for diabetes, make sure you check your blood sugar level
regularly and report any changes to your doctor.

TOPROL-XL may change how well your diabetes is controlled. It may also cover up some
of the symptoms of low blood sugar (hypoglycaemia). TOPROL-XL may increase the time
your body takes to recover from low blood sugar. Your doses of diabetic medicines,
including insulin, may need to change.

If you are about to be started on any new medicine, remind your doctor and pharmacist
that you are taking TOPROL-XL.

Tell any doctors, dentists, and pharmacists who are treating you that you are taking
TOPROL-XL.

If you plan to have surgery (even at the dentist) that needs an anaesthetic, tell
your doctor or dentist that you are taking TOPROL-XL.

If you have to have any medical tests while you are taking TOPROL-XL, tell your doctor.

TOPROL-XL may affect the results of some tests.

Things you must not do

Do not stop taking TOPROL-XL without checking with your doctor.

Your doctor may want you to gradually reduce the amount of TOPROL-XL you are taking
before stopping completely. This may help reduce the possibility of your condition
worsening or other heart complications occurring.

Do not give TOPROL-XL to anyone else even if they have the same condition as you.

Do not use TOPROL-XL to treat any other complaints unless your doctor tells you to.

Things to be careful of

Be careful driving or operating machinery until you know how TOPROL-XL affects you.

As with other beta-blocker medicines, TOPROL-XL may cause dizziness, light-headedness,
tiredness, or drowsiness in some people. Make sure you know how you react to TOPROL-XL
before you drive a car, operate machinery, or do anything else that could be dangerous
if you are dizzy or light-headed.

Be careful drinking alcohol while you are taking TOPROL-XL.

If you drink alcohol, dizziness or light-headedness may be worse.

Dress warmly during cold weather, especially if you will be outside for a long time
(for example when playing winter sports).

TOPROL-XL, like other beta-blocker medicines, tends to decrease blood circulation
in the skin, fingers and toes. It may make you more sensitive to cold weather, especially
if you have circulation problems.

Side effects

Tell your doctor or pharmacist as soon as possible if you do not feel well while you
are taking TOPROL-XL.

If you get any side effects, do not stop taking TOPROL-XL without first talking to
your doctor.

All medicines can have side effects. Sometimes they are serious, most of the time
they are not. You may need medical treatment if you get some of the side effects.

If you are over 65 years of age you may have an increased chance of getting side effects.

Ask your doctor or pharmacist to answer any questions you may have.

Tell your doctor if you notice any of the following and they worry you:

headache, tiredness, drowsiness, weakness, or lack of energy

aches and pains, painful joints

nausea (feeling sick), vomiting

stomach upset, diarrhoea or constipation, weight gain

dry mouth, changes in taste sensation

difficulty sleeping, nightmares

mood changes

confusion, short-term memory loss, inability to concentrate

increased sweating, runny or blocked nose

hair loss

These side effects are usually mild.

Tell your doctor or pharmacist immediately if you notice any of the following:

dizziness, light headedness or fainting especially on standing up, which may be a
sign of low blood pressure

tingling or "pins and needles"

coldness, burning, numbness or pain in the arms and/or legs

skin rash or worsening of psoriasis

sunburn happening more quickly than usual

abnormal thinking or hallucinations

buzzing or ringing in the ears, deafness

irritated eyes or blurred vision

problems with sexual function

constant "flu-like" symptoms with tiredness or lack of energy

unusual bleeding or bruising.

These are serious side effects. You may need urgent medical attention. Serious side
effects are rare.

If any of the following happen, tell your doctor or go to Accident and Emergency at
your nearest hospital immediately:

shortness of breath, being less able to exercise

swelling of the ankles, feet or legs

chest tightness, wheezing, noisy breathing, difficulty breathing

chest pain, changes in heart rate or palpitations

swelling of the face, lips, tongue or throat which may cause difficulty in swallowing
or breathing, which may be signs of a serious allergic reaction

yellowing of the skin or eyes (jaundice), generally feeling unwell.

These are very serious side effects. You may need urgent medical attention or hospitalisation.
These side effects are rare.

Other side effects not listed here may occur in some patients. Tell your doctor or
pharmacist if you notice anything that is making you feel unwell.

Do not be alarmed by this list of possible side effects.

You may not experience any of them.

After using TOPROL-XL

Storage

Keep your tablets in the blister pack until it is time to take them.

If you take TOPROL-XL out of the blister pack it will not keep well.

Keep the tablets in a cool dry place where the temperature stays below 30°C.

Do not store it or any other medicine in the bathroom or near a sink. Do not leave
it in the car or on window sills.

Heat and dampness can destroy some medicines.

Keep it where young children cannot reach it.

A locked cupboard at least one-and-a-half metres above the ground is a good place
to store medicines.

Disposal

Ask your pharmacist what to do with any tablets you have left over if your doctor
tells you to stop taking them, or you find that the expiry date has passed.

Product description

What TOPROL-XL looks like

TOPROL-XL 23.75 tablets are white to off-white, oval, scored on both sides and marked
A/Beta Symbol on one side. This tablet can be divided into equal doses.

TOPROL-XL 47.5 tablets are white to off-white, round, scored on one side and marked
A/mO on the other side. The score line is only there to help you break the tablet
if you have difficulty swallowing it whole.

TOPROL-XL 95 tablets are white to off-white, round, scored on one side and marked
A/mS on the other side. The score line is only there to help you break the tablet
if you have difficulty swallowing it whole.

TOPROL-XL 190 tablets are white to off-white, oval, scored on one side and marked
A/mY on the same side. The score line is only there to help you break the tablet if
you have difficulty swallowing it whole.

Samuel Lesko has more than 20 years experiences in running AFM over variety of applications.
After obtaining a PhD at Burgundy university on colloidal force measurement in cement, he started his career at Veeco Instruments as French Applications Scientists before to continue on supporting Bio Applications AFM European wide. He is since 2007 Applications manager for Europe, Middle East and Africa. Recently, his position expanded to Latin America.

There's a continued drive towards making in vitro assays ever more translational towards in vivo models and ultimately the clinic. This ties in with the resurgence of phenotypic screening and is a response to the perceived poor translation of the traditional simple cell-based assays, often developed to study just single protein targets.

Paul Morris is the Director of Professional Advancement for Specsavers Opticians in the UK and Ireland. The role involves furthering clinical scope, professional services, standards, training and forming future strategy for the group. He previously held the role of Director of Optometry Advancement.

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